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SPECIAL  REGULATIONS  NO.  28 

SANITARY  REGULATIONS 

AND  CONTROL  OF 
COMMUNICABLE  DISEASES 


1917 


WASHINGTON 

GOVERNMENT  PRINTING  OFFICE 
1917 


OLOGY 


SPECIAL  REGULATIONS  NO.  28. 


WAR  DEPARTMENT, 

WASHINGTON,  August  10,  1917. 
The  following  regulations  governing  the  subjects — 
I.  Sanitary  Regulations, 
II.  Control  of  Communicable  Diseases. 

are  published  for  the  information  and  guidance  of  all  con- 
cerned and  supersede  General  Orders  No.  45,  War  Department, 
1916. 

[300.42,  A.  G.  o.} 

BY  ORDER  OF  THE  SECBETABY  OF  WAB  I 

TASKER  II.  BLISS, 
Major  General,  Acting  Chief  of  Staff. 
OFFICIAL  : 

H.  P.  McCAIN, 

The  Adjutant  General. 


66?3i6 


'TABLE  OF  CONTENTS. 


Paragraphs. 

Sanitary   regulations 1-18 

Control  of  communicable  diseases 19-37 


SANITARY  REGULATIONS  AND  CONTROL,  OF  COMMUNICABLE 
DISEASES.        '    "' ••'  •     • 


SECTION  I. 

SANITARY  REGULATIONS. 

Paragraph. 

Responsibility  for  sanitation 1 

Division  surgeon 2 

Sanitary   inspector '. 3 

Sanitary  squads . 4 

Water  supply 5 

Kitchens  and  mess  halls 6 

Food  and  drinks 7 

Baths  and  lavatories 8 

Disposal  of  garbage 9 

Care  of  picket  lines  and  disposal  of  manure 10 

Disposal  of  excreta 11 

Personal  cleanliness 12 

Venereal  diseases 13 

Fitting  of  shoes  and  care  of  feet 14 

Physical  inspections  of  troops 15 

Sanitary  inspections  of  organizations " —  16 

Mosquito  breeding 17 

Flies 18 

1.  Responsibility  for  sanitation. — Commanders  of  all  grades 
are  responsible  for  police  and  sanitation  and  for  the  enforce- 
ment of  the  provisions  of  these  regulations  within  their  organi- 
zations. 

2.  Division  snrgeon. — The  division  surgeon  is  charged,  under 
the  commanding  general,  with  the  general  conduct  and  super- 
vision of  the  Medical  Department  of  the  division  in  the  per- 
formance of  its  duties,  and  will  make  recommendation  con- 
cerning all  matters  pertaining  to  the  sanitary  welfare  of  the 

command. 

1 


$  SANITARY  REGULATIONS  AND 

3.  Sanitary  inspector. — The  sanitary  inspector  is  assistant  to 
the  division  surgeon,  and  is  charged  especially  with  the  super- 
vision of  the  sanitation  of  the  command  to  which  he  is  assigned. 
It  is  the  duty  of  organization  commanders  to  remedy  defects 
reported  to  them  with  the  least  possible  delay. 

1.  Sanitary  s&vads  will  be  organized  by  the  division  surgeon 
for  special  sanitary  purposes,  such  as  the  purification  of  water 
supplies  mocQuito  and  fiy  prevention,  disposal  of  wastes,  and 
disinfection.  They  will  consist  of  officers,  noncommissioned 
officers,  and  privates,  first  class,  or  privates  of  the  Medical 
Department,  assisted  by  civilian  sanitary  laborers  employed 
by  the  Quartermaster  Corps,  and,  when  necessary,  by  details 
of  officers  and  enlisted  men  from  other  branches  of  the  service. 

5.  Water  supply. — In  the  field  water  must  not  be  used  for 
drinking  purposes  until  it  has  been  pronounced  fit  for  use  by 
a  medical  officer.     Care  must  be  taken  to  prevent  contamina- 
tion of  stored  water  by  keeping  all  containers  scrupulously 
clean  and  covered  in  such  manner  as  to  prevent  "  dipping,"  and 
the  entrance  of  dust  and  other  sources  of  infection.     The  use 
of  a  common  drinking  cup  will  not  be  permitted. 

An  appliance  carried  on  the  supply  table  as  "Water  bag, 
field,  sterilizing,"  consists  of  a  40-gallon  canvas  bag  of  spe- 
cially woven  flax,  20  inches  in  diameter  and  28  inches  in  length. 
The  purpose  of  the  bag  is  not  to  transport  water,  but  to  pro- 
vide a  stationary  receptacle  in  which  water  can  be  held  long 
enough  to  sterilize,  and  then  be  distributed.  The  empty  bag 
weighs  from  7  to  1\  pounds  and  folds  into  a  convenient  package 
for  carriage  in  the  field,  for  which  purpose  it  was  especially 
designed.  After  the  bag  is  suspended  and  filled,  the  water  is 
sterilized  by  the  addition  of  a  small  amount  of  hypochlorite  of 
calcium.  This  is  carried  in  measured  doses,  sealed  in  glass 
tubes.  The  process  is  one  of  oxidation.  In  the  strength  used, 
waters  highly  infected  are  rendered  safe.  Water  ordinarily 
used  will  be  entirely  safe  after  being  so  treated.  As  the 
chemical  acts  more  efficiently  in  clear  waters,  a  filter  cloth,  to 
be  fastened  over  the  opening  of  the  bag  and  weighing  1  ounce 
is  provided,  or  water  may  be  strained  through  a  blanket.  Sus- 
pended matter,  such  as  clay,  is  largely  removed  and  not  left  to 
interfere  with  the  action  of  the  chlorin.  The  bag  is  filled  after 
it  is  put  in  place. 

6.  Kitchens  and  mess  halls. — Kitchens  and  mess  halls  will  be 
securely  screened  and  flytraps  provided  for  catching  flies  that 
gain  entrance.    An  effective  flytrap  consisting  of  a  light  wooden 


CONTROL  OF  COMMUNICABLE  DISEASES.  9 

frame  covered  with  wire  gauze,  extending  to  about  one-eighth 
of  an  inch  from  the  floor  of  the  trap,  is  readily  constructed. 
Sweetened  water,'  slightly  acidulated  with  vinegar,  is  an  excel- 
lent bait.  Fly  paper  may  also  be  used.  All  food,  food  receptacles, 
dishes,  and  tableware  will  be  protected  from  flies  and  dust.  Unit 
commanders  will  see  that  an  amn^le  supply  of  hot  water  and  dish 
towels  are  provided  for  cleansing  cooking  utensils,  dishes,  and 
mess  kits.  Ice  boxes  will  be  kept  elevated  at  a  height  sufficient 
to  allow  for  inspection  and  cleansing.  Drip  pans  will  be  emptied 
and  scalded  out  daily. 

7.  Food  and  drinks. — No  food  or  like  commodities  will  be  sold 
in  camp  except  in  the  authorized  exchanges. 

Bills  of  fare  should  be  prepared  in  advance  and  adhered  to  as 
far  as  is  practicable. 

Attention  is  called  to  the  use  of  the  following  foods,  the  elimi- 
nation of  which  from  the  messes  will  serve  to  prevent  a  variety 
of  intestinal  disorders : 

(a)  Canned  milk  and  fish  opened  the  day  before.  (Milk  and 
fish  poisoning. ) 

( & )  Hashes  of  meats  and  potatoes  prepared  the  night  previous. 
(Ptomaine  poisoning  of  severe  type.) 

(c)  In  certain  localities  green  vegetables,  uncooked.  (Dysen- 
teries and  diarrhea.) 

8.  Baths  and  lavatories. — Careful  inspection  will  be  made  daily 
to  see  that  waste  water  is  so  disposed  of  as  to  prevent  mosquito 
breeding  and  other  nuisances. 

9.  Disposal   of   garbage. — For   detachments   or  companies  in 
camps,  or  in  isolated  locations  where  other  means  of  disposal  are 
not  available,  an  incinerator  will  be  installed  of  a  type  approved 
by  the  sanitary   inspector.     The  Guthrie  incinerator  may  be 
used,  detail  drawing  for  the  construction  of  which  may  be  found 
in  the  Manual  for  the  Quartermaster  Corps.     Where  disposal 
in  a  sanitary  manner  can  be  made  by  cartage,  the  garbage  may 
be  carried  away  in  the  can  and  disposed  of.    The  returned  can 
will  be  thoroughly  cleansed.    Cans  will  be  kept  tightly  covered 
on  open  stands. 

10.  Care  of  picket  lines  and  disposal  of  manure. — Picket  lines 
will  be  kept  broom  swept,  and  all  manure  and  straw  hauled  away 
daily  and  burned,  or  otherwise  disposed  of  as  directed  by  the 
sanitary  inspector.     A  weekly  incineration  of  the  picket  lines 
will  be  accomplished  with  the  use  of  crude  oil.    Crude  oil  may 
be  obtained  from  the  Quartermaster  Corps  on  usual  requisition. 

4620°— 17 2 


10  SANITARY  REGULATIONS  AND 

11.  Disposal  of  excreta. — In  permanent  camps  where  a  water- 
carriage  system  is  not  installed,  the  Havard  or  other  fly-tight 
box  and  pit  latrine  will  be  used.    Each  day  the  pit  will  either 
be  burned  out  or  sprayed  with  a  lampblack  or  bone-black  mix- 
ture.   If  burned  out,  1  gallon  of  crude  oil  and  15  pounds  of  hay 
or  straw  should  be  used.    A  satisfactory  mixture  for  spraying 
consists  of  one-half  pound  of  lampblack  to  a  gallon  of  kero- 
sene, or  1  pound  of  bone  black  to  3  gallons  of  crude  oil.    Spray- 
ing should  be  done  preferably  with  a  spray  pump.     Both  the 
interior  of  the  box  and  of  the  pit  should  be  kept  thoroughly 
coated  with  the  mixture.     Detail  drawing  of  the  Havard  box 
may  be  found  in  the  Manual  for  the  Quartermaster  Corps.    The 
box  must  be  kept  fly-tight.     This  implies  closure  of  all  cracks 
and  care  of  hinges  and  back  construction,  so  that  the  lids  drop 
automatically.    The  latrine  seats  will  be  scrubbed  with  soap  and 
water  daily,  and  washed  off  at  least  twice  weekly  with  a  y^ 
solution  of  creolin  or  other  disinfectant.    When  filled  to  within 
2  feet  of  the  top,  pits  will  be  filled  with  earth  to  within  6  inches 
of  the  surface  and  covered  with  a  layer  of  sacking,  soaked  in 
crude  oil  to  extend  3  feet  beyond  the  edges  of  the  pit ;  the  pit 
will   then  be  filled  in  with  earth  and  the  location  marked. 
Urinal  cans  will  be  placed  in  the  camp  streets  at  night  and 
removed  in  the  morning,  emptied,  and  burned  out.     Facilities 
for  washing  the  hands  should,  if  possible,  be  provided  in  each 
latrine. 

12.  Personal  cleanliness. — Every  member  of  the  command  will 
bathe  at  least  twice  weekly.     Army  Regulations    (par.   286) 
require  that  the  men  shall  wash  their  hands  before  each  meal 
and   immediately   after   visiting   the  latrines.     Teeth   will   be 
cleansed  w^ith  a  brush  at  least  once  a  day.    Underwear  should 
be  frequently  changed.     Bedding  and  clothing  will  be  sunned 
and  tent  walls  raised  daily,  weather  permitting.    Barracks  and 
tents  will  be  adequately  ventilated.     Tents  will  be  furled  or 
struck  frequently,  so  that  the  sites  may  be  thoroughly  sunned. 

13.  Venereal  diseases. — The  cause  of  these  diseases  is  a  matter 
of  common  knowledge.    They  are  entirely  preventable,  and  the 
Government  punishes  those  who  expose  themselves  and  contract 
venereal  disease  by  prompt  stoppage  of  pay  and  restriction  of 
privileges  while  under  treatment. 

It  is  enjoined  upon  all  officers  serving  with  troops  to  do  their 
utmost  to  encourage  healthful  exercises  and  physical  recreation, 
and,  to  supply  opportunities  for  cieaaly  social  aiKl  interesting 


y 

CONTROL  OF  COMMUNICABLE  DISEASES.  11 

mental  occupations  for  the  men  under  their  command ;  to  take 
advantage  of  favorable  opportunities  to  point  out,  particularly 
to  the  younger  men,  the  inevitable  misery  and  disaster  which 
follow  upon  intemperance  and  moral  uncleanliness,  and  that 
venereal  disease,  which  is  almost  sure  to  follow  licentious  liv- 
ing, is  never  a  trivial  affair.  Although  the  chief  obligation  and 
responsibility  for  the  instruction  of  soldiers  in  these  matters 
rests  upon  company  officers,  the  medical  officers  should  co- 
operate by  occasional  lectures  or  other  instruction  upon  the 
subject  of  sexual  physiology  and  hygiene,  and  the  dangers  of 
venereal  infection. 

Commanding  officers  will  require  that  men  who  expose  them- 
selves to  the  danger  of  contracting  venereal  disease  shall  at  once, 
upon  their  return  to  camp  or  garrison,  report  to  the  hospital  or 
dispensary  for  the  application  of  such  cleansing  and  prophylac- 
tic treatment  as  may  be  prescribed  by  the  Surgeon  General. 
Any  soldier  who  fails  to  comply  with  such  instructions,  if  found 
to  be  suffering  from  a  venereal  affection,  shall  be  brought  to 
trial  by  court-martial  for  neglect  of  duty. 

Cases  of  these  diseases  will  be  promptly  subjected  to  treat- 
ment, but  not  necessarily  excused  from  duty  unless,  in  the  opin- 
ion of  the  surgeon,  it  is  deemed  desirable.  They  will  be  made 
of  record  in  the  medical  reports  in  any  case.  A  list  of  those 
diseased  but  doing  duty  will  be  kept  both  by  the  company  or 
detachment  commander  and  the  surgeon,  and  the  infected  men 
will  be  required  to  report  to  a  medical  officer  for  systematic 
treatment  until  cured.  While  in  the  infectious  stages  the  men 
should  be  confined  strictly  to  the  limits  of  the  post.  When  a 
venereal  case,  whether  or  not  on  sick  report,  is  transferred  to 
another  command,  the  surgeon  will  send  a  transfer  slip  giving 
a  brief  history  of  the  case. 

14.'  Fitting  of  shoes  and  care  of  feet. — Company  commanders 
are  charged  with  personal  supervision  of  fitting  the  shoes  of 
the  men  of  their  commands,  and  will  be  held  responsible  that 
instructions  herein  contained  nre  followed  and  that  their  men 
are  required  to  wear  shoes  properly  fitted.  To  determine  the 
fact  of  fit  the  shoes  will  be  laced  snugly,  and  the  soldier,  with 
a  40-pound  burden  upon  his  back,  will  throw  his  entire  weight 
on  one  foot.  The  officer  or  noncommissioned  officer  fitting  the 
shoe  will  then  press  in  the  leather  of  the  shoe  in  front  of  the 
toes  to  determine  the  existence  of  sufficient  vacant  space  in  that 
region  to  prevent  toe  injury,  Uu4er  no  circumstances  should  tbl§ 


12  SANITARY  REGULATIONS  AND 

vacant  space  in  front  of  the  great  toe  be  less  than  two-thirds  of 
an  inch,  nor  should  there  be  pressure  on  the  top  of  the  toes. 
The  officer  or  noncommissioned  officer  will  then  grasp  with  his 
hand  the  leather  of  the  shoe  over  the  ball.  As  his  fingers  and 
thumb  are  brought  slowly  together  over  the  leather  the  shoe 
should  feel  snugly  filled  without  apparent  tension,  while  the 
leather  should  lie  smoothly  under  the  hand.  If  the  leather 
wrinkles  under  the  grasp  of  the  hand,  the  shoe  is  too  wide  and 
a  narrower  width  is  needed;  if  the  leather  seems  tense  and 
bulgy  and  the  hand  tends  to  slip  over  easily,  the  shoe  is  too 
narrow  and  a  greater  width  is  necessary. 

Usually  it  will  be  necessary  to  try  on  several  pairs  of  shoes 
in  this  manner  before  an  entirely  satisfactory  shoe  is  secured. 
No  shoes  will  be  issued  or  worn  by  enlisted  men  which  are 
not  fitted  in  accordance  with  this  order. 

All  shoes  should  be  properly  broken  in  before  beginning  a 
march.  The  following  is  required : 

The  soldier  stands  in  his  new  shoes  in  about  2£  inches  of  water 
for  about  five  minutes  until  the  leather  is  thoroughly  pliable 
and  moist;  he  should  then  walk  for  about  an  hour  on  a  level 
surface,  letting  the  shoes  dry  on  his  feet,  to  the  irregularities 
of  which  the  leather  is  thus  molded  in  the  same  way  as  it  was 
previously  molded  over  the  shoe  last.  On  taking  the  shoe  off  a 
very  little  neat's-foot  oil  should  be  rubbed  into  the  leather  to 
prevent  its  hardening  and  cracking. 

If  it  is  desired  to  waterproof  the  shoes  at  any  time,  a  con- 
siderable amount  of  neat's-foot  oil  should  be  rubbed  into  the 
leather. 

Light  woolen  or  heavy  woolen  socks  will  habitually  be  worn 
for  marching;  the  socks  will  be  large  enough  to  permit  free 
movement  of  the  toes,  but  not  so  loose  as  to  permit  of  wrinkling. 
Darned  socks,  or  socks  with  holes,  will  not  be  worn  in  marching. 

Company  commanders,  by  frequent  inspections  throughout  the 
year,  will  maintain  the  feet  of  their  men  in  condition  for  proper 
marching.  They  will  cause  the  proper  trimming  of  nails,  removal 
of  pressure  from  corns  and  callouses,  relief  of  painful  bunions, 
treatment  of  ingrowing  nails,  and  other  defects,  sending  serious 
cases  to  the  surgeons. 

Before  a  march  is  undertaken  by  foot  troops  company  com- 
manders will  personally  inspect  the  bare  feet  of  their  men. 
While  on  the  march  they  will  personally  see  each  day  that  their 
men  wash  their  feet  as  soon  as  possible  after  reaching  camp, 


14.  Fitting  of  shoes  and  care  of  feet— On  page  12,  be- 
tween the  twenty-eighth  and  twenty-ninth  lines,  insert  the  fol- 
lowing: 

Shoes  issued  to  enlisted  men  will  be  regularly  inspected  by 
company  commanders  to  see  that  waterproofing  substance  is 
applied  often,  and  that  they  are  not  injured  by  being  placed  too 
near  heating  apparatus.  Heat  ruins  leather  and  causes  wet 
leather  to  rapidly  decompose.  (S.  R.  No.  28,  C.  No.  1,  Apr.  1, 
1918.) 


CONTROL  OF  COMMUNICABLE  DISEASES.  13 

prick  and  evacuate  blisters,  and  cover  such  blisters  or  excoria- 
tions with  zinc  oxide  plaster,  supplied  by  the  Medical  Depart- 
ment, applied  hot,  dust  the  feet  with  the  foot  powder  supplied 
by  the  Medical  Department,  and  put  on  clean  socks.  An  undue 
amount  of  foot  injury  and  disability  from  shoes  will  be  re- 
garded as  evidence  of  inefficiency  on  the  part  of  the  officers 
concerned,  and  as  causes  for  investigation. 

Quartermasters  will  provide  a  place  where  shoes  may  be 
fitted  for  the  purpose  of  determining  or  verifying  the  record  to 
be  kept  in  each  company,  troop,  battery,  and  detachment  of  1!u» 
proper  sizes  of  shoes  required  for  each  enlisted  man  thereof. 
For  the  purpose  of  fitting  they  \vill  keep  on  hand  at  all  times 
a  complete  series  of  each  size  and  width  of  shoes  furnished  for 
issue.  Company  commanders  will  report  in  writing  to  the  next 
higher  commander  every  instance  of  failure  to  secure  proper 
shoes  for  their  commands,  or  to  obtain  proper  facilities  for  fitting 
the  shoes  as  herein  directed.  Commanders  will  investigate  the 
reasons  for  and  be  held  responsible  as  far  as  lies  in  their  power 
for  the  rectification  of  such  deficiencies. 

A  brief  record  of  the  number  of  such  reports  from  company 
commanders  and  the  reason  for  such  deficiencies  will  be  fur- 
bished to  inspectors  at  each  inspection. 

Inspections  conducted  under  the  provisions  ot  paragraph  889, 
Arm.,  Regulations,  will  embrace  an  inquiry  into  the  manner  in 
which  this  order  has  been  complied  with,  and  the  report  of 
inspections  will  include  a  statement  of  all  instances  of  failure 
on  the  part  of  company  commanders  to  secure  proper  shoes  for 
their  commands  and  the  cause  of  such  failure. 

15.  Physical  inspections  of  troops. — Commanding  officers  will 
require  a  medical  officer,  accompanied  by  the  company  or  detach- 
ment commander,  tc  make  a  thorough  physical  inspection  twice 
in  each  month  of  all  the  enlisted  men  of  each  organization  be- 
longing to  or  attached  to  the  command.  These  inspections  will 
be  made  at  times  not  known  beforehand  to  the  men,  and  prefer- 
ably immediately  after  a  formation.  The  dates  on  which  the 
physical  inspections  of  the  various  organizations  are  made  will 
be  noted  on  the  monthly  sanitary  reports. 

At  these  inspections  an  examination  of  the  feet  and  footwear 
and  of  the  condition  of  personal  cleanliness  of  the  men  will  be 
mnde,  as  well  as  careful  observation  for  the  detection  of  venereal 
diseases. 


J 

14  •         SANITARY  HEGTJLATlONS,  ETd. 

16.  Sanitary  inspections  of  organizations. — Surgeons  of  organi- 
zations will  make  a  daily  inspection  of  the  commands  to  which 
they    pertain,    giving   particular    attention   to    the    following: 
Picket  lines  ;  latrines ;  kitchens  and  mess  halls,  including  cleanli- 
ness of  cooks,  utensils,  and  fixtures;  barracks  and  tents;  in- 
closed toilets ;  baths ;  lavatories ;  laundries ;  exchanges ;  garbage 
receptacles;    incinerators;    and    all    food   supplies.     They   will 
make  a  verbal  report  at  once  to  their  respective  commanding 
officers  for  the  correction  of  any  sanitary  defects  noted,  and  a 
similar  report,  with  the  action  taken,  to  the  sanitary  inspector 
on  his  next  visit. 

17.  Mosquito   breeding. — Areas   about  camps   in  which  mos- 
quitoes might  breed,   such  as  cisterns,  tanks,  woods,   gutters, 
pools,  and  drains,  will  be  kept  under  close  observation  by  the 
responsible  medical  officers  and  the  proper  remedies  applied, 
i.  e.,  screening,  draining,  oiling,  etc.     The  use  of  the  mosquito 
bar  is  imperative  in  all  districts  where  mosquitoes  are  preva- 
lent, except  where  tents  or  barracks  are  effectually  screened 
with  wire. 

18.  Flies. — All  possible  breeding  places  of  flies  should  be  de- 
stroyed, particular  attention  being  given  to  manure  and  refuse 
from  picket  lines  and  stables.    An  energetic  campaign  must  be 
begun  at  once  against  the  mature  flies. 


SECTION  II. 

CONTROL  OF  COMMUNICABLE  DISEASES. 

Paragraph. 

Purpose 19 

Main  object  of  sanitary  science 20 

Environment 21 

Principal  routes  of  infection 22 

Program 23 

Typhoid    fever 24 

Paratyphoid   fever 25 

Cholera 26 

Dysentery 27 

The  intestinal  group  of  diseases 28 

Epidemic   meningitis 29 

Malaria 30 

Yellow  fever 31 

Typhus  fever 32 

Epidemic  jaundice 33 

Smallpox 34 

Vaccination 35 

Measles,  mumps,  and  scarlet  fever 36 

Venereal  diseases 37 

19.  Purpose. — In  carrying  out  effective  sanitary  measures  in 
the  military  service  particular  attention  should  be  paid  to  cer- 
tain of  the  communicable  diseases.     The  following  notes  are 
published  for  the  information  and  guidance  of  medical  officers 
and  others  whose  duties  impose  upon  them  the  prevention  of 
disease  among  the  troops  of  the  United  States. 

20.  Main  object  of  sanitary  science. — The  practice  of  modern 
sanitary  science  may  be  summarized  in  the  statement  that  its 
main  object  is  to  seek  the  sources  amongst  infected  persons 
and    animals    whose   excreta    or    other    constituents    or    body 
contents  enter  the  bodies  of  other  persons.     Its  main  postulate 
is  that  the  routes  of  infection  are  simply  the  routes  of  infected 
bodily  discharges,  which  are  the  routes  of  ordinary  uninfected 
discharges  in  ordinary  life. 

15 


16  SANITARY  REGULATIONS  AND 

21.  Environment. — The  influence  of  environment  depends  upon 
whether  or  not  it  permits  of  or  necessitates  the  exchange  of 
human  discharges.     Overcrowding,   if  combined  with  lack  of 
discipline  and  order,  and  lack  of  facilities  for  washing,  espe- 
cially of  the  hands,  contributes  to  the  spread  of  infection,  not 
of  itself,   but  only   if  infection  be   introduced   into   the  com- 
munity.    Overcrowding,  if  there  is  discipline  and  intelligence, 
writh  proper  precautions  to  avoid  the  exchange  of  excreta,  does 
not  spread  infection  even  if  it  be  introduced. 

22.  Principal  routes  of  infection. — Water,  food,  flies,  and  milk 
are  the  main  public  routes  of  gastrointestinal  infection  from 
individuals  to  group,  and  from  group  to  group.    Contact  is  the 
great  private  route  from  individual  to  individual.     Contact  in- 
fection radiates  directly  from  the  infected  person  through  nose, 
mouth,  bladder,  and  bowel  discharges.    The  great  route  of  ex- 
change is  by  smears  on  the  hands,  although  mouth  spray  and 
sputum  also  act  in  many  diseases.     If  we  classify  the  chief 
communicable  diseases  of  the  Temperate  Zone  by  their  prin- 
cipal routes  of  infection,  we  plainly  see  that  of  all  the  routes 
contact  alone  is  common  to  all  diseases. 

23.  Program. — A  program  of  military  sanitation  should  aim: 
(a)  To  secure  to   each  individual  continuously  the  highest 

possible  health. 

(&)  To  secure  to  each  instruction  and  training  in  personal 
conduct  in  order  to  avoid  receiving  into  his  body  the  discharge 
of  infected  persons. 

(c)  To  secure  to  each  specific  immunization. 

These  three  measures  place  the  abolition  of  infection  directly 
upon  the  individual.  The  three  following  place  the  abolition  of 
infection  upon  experts  who  deal  directly  with  the  infection 
itself: 

(a)  The  supervision  of  the  four  great  public  routes  of  infec- 
tion, to  exclude  all  bodily  discharges  from  them. 

( & )  The  supervision  of  all  known  infectious  cases,  to  exclude 
their  discharges  from  all  routes. 

(c)  The  sociological  supervision  of  all  infected  persons. 

24.  Typhoid  fever. — Cause. — The  bacterial   cause  of  typhoid 
fever  is  a'  rod-shaped  microorganism  or  germ  called  the  typhoid 
bacillus. 

Nature. — Typhoid  fever  is  chiefly  a  filth  disease,  and  is  widely 
distributed  over  the  world.  The  typhoid  bacillus  is  present  in 
the  feces  and  urine  of  all  persons  who  are  ill  with  the  disease, 


CONTROL  OF  COMMUNICABLE  DISEASES.  17 

and  of  certain  persons  who  have  long  recovered  from  it.  The 
latter  persons  are  referred  to  as  carriers  of  the  bacilli,  or 
typhoid  carriers. 

Means  of  communication. — Lack  of  care  in  the  disposal  of  the 
excreta  and  want  of  personal  cleanliness  are  the  chief  sources 
of  the  disease.  A  faulty  method  of  disposing  of  feces  and  urine 
may  lead  to  contamination  of  drinking  water,  milk,  or  other 
food  directly  or  through  the  agency  of  flies. 

Human  excrement  should  be  properly  disposed  of,  breeding 
places  of  flies  destroyed,  food  supplies  protected,  and  persistent 
warfare  against  the  fly  unceasingly  curried  on. 

Sources  of  the  disease  in  military  camps. — The  commonest 
mode  of  infection  in  military  establishments  is  through  personal 
contact,  especially  by  means  of  the  hands,  with  individuals  who 
harbor  the  typhoid  bacillus.  Sometimes  this  contact  is  direct, 
sometimes  indirect.  About  60  per  cent  of  the  cases  are  believed 
to  arise  in  this  manner. 

The  direct  instances  are  those  in  which  infection  follows 
upon  personal  association  with  an  infected  person  or  carrier. 
The  indirect  ones  are  such  as  arise  from  clothing,  bedding,  water, 
milk,  or  other  foods,  and  the  dishes  or  drinking  cup  of  an  infected 
person. 

The  carrier  is,  therefore,  because  unsuspected  and  more  in- 
sidious, a  greater  source  of  danger  than  the  sick  person.  The 
medical  officer  should  be  on  the  alert  to  suspect  and  detect  him. 
Once  detected,  he  requires  particular  care  in  respect  to  isolation 
and  treatment.  The  carriers  who  handle  or  prepare  food  are 
especially  dangerous.  In  order  to  avoid  increase  in  carriers,  no 
patient  convalescent  from  typhoid  fever  should  be  released  until 
three  successive  examinations  of  the  stools  and  urine,  collected 
at  six-day  intervals,  have  shown  him  to  be  free  from  typhoid 
bacilli. 

Personal  precautions  to  be  observed. — From  what  has  been 
stated  it  is  obvious  that  habits  of  personal  cleanliness  are  to  be 
encouraged  in  every  way.  Bathing  should  be  frequent,  the  wash- 
ing of  the  hands  before  eating  and  after  visiting  the  latrine 
should  be  obligatory,  and  due  attention  paid  to  the  laundering 
of  underclothing.  The  eating  and  other  utensils  used  by  per- 
sons sick  of  typhoid  fever  and  carriers  of  the  typhoid  bacilli 
should  be  promptly  sterilized. 


18  SANITARY  REGULATIONS  AND 

25.  Paratyphoid  fever. — Causes. — Like  typhoid  fever,  paraty- 
phoid fever  is  produced  by  bacteria.  Two  bacilli,  known  as 
paratyphoid  A  and  B,  are  its  bacterial  causes. 

Nature. — Paratyphoid  fever,  like  typhoid  fever,  is  a  filth 
disease,  and  as  such  is  to  be  dealt  with  precisely  as  is  typhoid 
fever.  In  addition,  the  paratyphoid  bacilli  B  occur  in  animals 
and  may  be  present  in  their  flesh.  Hence,  such  infected  foods, 
when  improperly  cooked  or  preserved,  may  give  rise  to  paraty- 
phoid fever.  This  form  of  the  disease  constitutes  one  of  the 
kinds  of  food  or  meat  poisoning.  Healthy  carriers  of  the  para- 
typhoid bacillus  also  exist. 

Vaccination. — Typhoid  vaccination  does  not  protect  against 
paratyphoid  infection.  It  is,  therefore,  necessary  to  vaccinate 
against  paratyphoid,  as  well  as  against  typhoid  fever.  For  this 
purpose  a  vaccine  is  supplied  containing  both  the  A  and  B 
bacilli.  It  is  injected  in  the  same  manner  as  the  typhoid  bacillus 
vaccine. 

Distinction  between  typhoid  and  paratyphoid  fever. — These  two 
kinds  of  fever  are  often  indistinguishable  clinically.  But  labora- 
tory test  methods  serve  to  distinguish  them  from  each  other. 
Every  case  of  undetermined  fever  and  every  case  of  clinical 
typhoid  or  paratyphoid  fever  should  have  a  blood  culture  made 
not  later  than  the  fifth  day,  this  culture  to  be  examined  at  an 
Army  laboratory,  unless  specific  authority  to  do  otherwise  is  given 
by  the  Surgeon  General's  office.  A  subculture  from  any  positive 
blood  culture  will  be  sent  to  the  nearest  department  laboratory 
for  confirmation  and  record. 

Typhoid  and  paratyphoid  vaccination. — All  persons  entering 
the  military  service  will  be  vaccinated  against  typhoid  and 
paratyphoid  fevers,  under  the  direction  of  the  medical  officer, 
as  soon  as  practicable  after  entrance.  Exception  may  be  made 
in  the  case  of  persons  over  45  years  of  age,  and  when  the  occur- 
rence of  a  previous  attack  of  typhoid  fever  or  a  complete  course 
of  vaccination  within  three  years  is  established  to  the  satis- 
faction of  the  responsible  medical  officer. 

Officers  under  45  years  of  age  will  be  vaccinated  after  three 
years,  and  enlisted  men  on  reenlistrnent. 

Vaccination  will  consist  of  a  series  of  three  injections  given 
exactly  as  in  the  first  series. 

Recruits  will  be  vaccinated  at  places  of  enlistment,  unless,  be- 
cause of  special  assignment  or  other  reason,  the  men  are  not 
to  remain  at  the  station  long  enough  to  allow  the  completion  of 
the  course,  in  which  event  the  vaccination  will  be  completed 


CONTROL  OF  COMMUNICABLE  DISEASES.          19 

immediately  after  they  join  the  organizations  or  stations  to 
which  they  are  assigned.  On  page  2  of  the  service  record  of 
every  recruit  or  enlisted  man  will  be  entered  the  dates  of  com- 
pletion of  vaccination  against  typhoid  and  paratyphoid  fevers. 
The  absence  of  any  date  in  the  line  provided  for  that  purpose 
will  indicate  that  the  vaccination  has  not  been  administered. 
Company  and  detachment  commanders  will  examine  the  service 
records,  and,  if  the  vaccination  has  not  been  completed,  will  see 
that  the  vaccination  is  begun  immediately  after  the  men  join 
the  organizations  or  stations  to  which  assigned. 

Civilian  employees  who  are  subject  to  field  service  of  any  kind, 
including  those  on  transports  and  in  the  mine-planter  service, 
will  be  vaccinated  as  soon  as  employed. 

Records  will  be  kept  of  all  officers,  soldiers,  and  civilians  in 
the  military  service  who  receive  the  antityphoid  and  antipara- 
typhoid  vaccinations,  giving  the  dates  of  vaccination. 

The  following  directions  for  vaccination  against  typhoid  and 
paratyphoid  fevers  are  published  here  for  the  information  of 
medical  officers: 

The  first  dose  is  one-half  cc.  (7$  m.) ;  the  second  and  third 
are  each  1  cc.  (15  m.).  An  interval  of  at  least  seven  days 
should  elapse  between  doses.  This  interval  may  be  extended 
to  the  fourteenth  day  in  case  of  necessity. 

The  site  of  inoculation  is  the  arm,  at  the  insertion  of  the 
deltoid  muscle.  If  for  any  reason  this  site  can  not  be  used, 
the  needle  may  be  introduced  into  the  back,  over  the  lower  por- 
tion of  the  scapula,  or  in  the  chest  below  the  clavicle.  The 
dose  is  to  be  given  subcutaneously,  and  not  into  the  muscles 
nor  into  the  skin.  The  arm  should  be  cleansed  as  for  any  other 
operation.  Tincture  of  iodine  painted  over  the  dry  skin,  before 
and  after  the  injection,  has  proven  satisfactory. 

The  ampule  should  be  washed  off  in  an  antiseptic  solution 
and  opened  after  making  one  or  more  cuts  near  the  top  with  a 
file.  The  vaccine  can  be  drawn  out  of  the  container  with  a 
syringe,  or  it  may  be  emptied  into  a  shallow  glass  dish,  such  as 
a  salt  cellar,  which  has  been  sterilized  by  boiling. 

The  syringe  and  needle  should  be  sterilized  by  boiling  in  2 
per  cent  soda  solution.  To  insure  perfect  sterilization,  draw 
the  piston  out  to  its  full  length,  or  remove  it  entirely  so  that 
the  barrel  is  full  of  water  during  the  boiling.  A  fresh  needle 
should  be  used  for  each  man,  or  if  one  needle  must  be  used  on 
two  or  more  men,  it  should  be  resterilized  before  each  injection. 


20  SANITARY  REGULATIONS  AND 

No  person  should  be  vaccinated  who  is  not  perfectly  healthy 
and  free  from  fever.  The  temperature  should  be  taken  in 
doubtful  cases,  and  the  urine  should  be  examined ;  if  fever  or 
any  other  symptoms  of  illness  are  present  the  procedure  should 
be  postponed.  These  precautions  are  necessary  to  avoid  vacci- 
nating men  who  may  be  in  the  incubation  stage  of  typhoid  or 
other  fever.  Neither  beer  nor  alcohol  in  any  other  form  should 
be  drunk  on  the  day  of  treatment.  Vaccination  is  well  borne 
by  children  and  by  women,  using  doses  proportionate  to  the 
body  weight,  taking  150  pounds  as  the  unit.  Women  should 
not  be  given  the  first  dose  during  or  near  the  time  of  the  men- 
strual period. 

The  most  suitable  time  for  the  administration  is  about  4 
o'clock  in  the  afternoon,  as  the  greater  part  of  the  reaction  is 
then  over  before  morning.  There  is  usually  some  headache  and 
malaise,  and  a  local  reaction  consisting  of  a  red  and  tender 
area  about  the  size  of  the  palm  of  hand,  and  sometimes  tender- 
ness in  the  axillary  glands.  It  is  best  not  to  require  any  duty 
for  24  hours,  nor  to  permit  active  exercise,  such  as  long  rides 
or  walks.  Rarely,  marked  general  reactions  occur — headache, 
backache,  nausea,  vomiting,  herpes  labialis,  occasionally  albu- 
minuria,  and  some  loss  of  body  weight.  The  number  of  such 
reactions  is  exceedingly  small,  and  regardless  of  their  severity 
they  as  a  rule  disappear  inside  of  48  hours. 

The  Widal  reaction  is  positive  after  typhoid  vaccination, 
appearing  in  about  10  days  after  the  first  dose,  and  it  remains 
positive  for  six  months  to  a  year.  This  fact  must  be  considered 
in  diagnosing  typhoid  in  vaccinated  persons.  They  may  give  a 
positive  Widal  regardless  of  the  nature  of  the  illness,  and  the 
reaction  is  frequently  of  no  assistance  in  diagnosis. 

The  vaccines  should  be  stored  in  an  ice  box.  They  will  keep 
for  four  months,  and  perhaps  longer  when  stored  at  low  tempera- 
tures in  the  dark.  A  fresh  ampule  should  be  opened  for  each 
day's  use.  Any  vaccine  remaining  unused  in  an  open  ampule  at 
the  end  of  the  day  should  be  thrown  away.  The  only  vaccines 
used  will  be  those  obtained  from  the  Army  Medical  School, 
and  will  be  furnished  on  request  by  letter  or  by  telegram  to  the 
department  surgeon.  When  for  any  reason  a  larger  stock  is  on 
hand  than  appears  to  be  needed,  directions  as  to  disposition 
will  be  obtained  from  the  commandant,  Army  Medical  School, 
upon  application  to  him  directly,  stating  date  of  receipt  of  the 


CONTROL  OF  COMMUNICABLE  DISEASES.  21 

vaccine.     Stock  over  four  months  old  will  be  destroyed  when 
a  new  supply  has  been  received. 

26.  Cholera. — Cause. — The   bacterial    cause    of   cholera    is    a 
comma-shaped  bacillus  known  as  the  comma  or  cholera  bacillus. 

Nature. — Two  main  forms  of  cholera  are  distinguished.  In 
one  type  of  the  disease  large  epidemics  break  out  more  or  less 
suddenly.  In  these,  cases  the  cholera  bacillus  is  contained  in 
the  drinking  water.  In  the  other  form  of  the  disease  the  rase* 
occur  separately  and  occasionally;  they  arise  from  contact  with 
other  cases  of  cholera,  with  cholera  bacillus  carriers,  or  from 
filth  contamination  by  flies,  as  in  the  manner  of  spread  of 
typhoid  fever. 

The  cholera  bacillus  breeds  in  the  intestine  of  man  and  escapes 
with  the  intestinal  discharges.  Gaining  access  to  water  sup- 
plies, it  survives  there  for  a  time.  Upon  the  hands,  clothing, 
etc.,  it  may  be  carried  to  healthy  persons  by  contact.  In  the 
cholera  patient  only  -the  intestinal  discharges  contain  the 
bacilli. 

Prevention. — The  control  of  the  drinking  water  is  imperative 
to  avoid  water-borne  epidemics.  The  cleansing  of  the  hands, 
disinfection  of  clothing,  bedding,  eating  utensils,  etc.,  are  neces- 
sary to  prevent  contact  infection.  The  discovery  and  isolation 
of  carriers,  who  in  infected  localities  may  constitute  from  5  to 
10  per  cent  of  the  population,  should  be  assiduously  attended 
to.  Carriers  are  an  especial  menace  when  they  are  engaged  in 
the  handling  and  preparation  of  food.  Should  cholera  appear, 
the  things  to  be  especially  kept  in  mind  are : 

(1)  Close  watch  over  the  persons  who  have  to  do  with  the 
handling  of  food. 

(2)  The  safeguarding  of  water  and  milk.    The  latter  should 
always  be  boiled  before,  use. 

(3)  The  use  only  of  food  recently  cooked. 

(4)  The  screening  of  kitchen  and  mess  halls. 

(5)  The  reduction  of  flies  by  trapping  and  killing,  and  the 
destruction  of  their  breeding  places. 

27.  Dysentery. — Causes  and  nature. — Dysentery,  or  inflamma- 
tion of  the  large  intestine,  is  caused  by  two  classes  of  micro- 
organisms, an  amoeba  and  certain  bacteria.     The  former  gives 
rise  to  amoebic,  the  latter  of  bacillary,  dysentery.    The  bacterial 
or  bacillary  form  of  dysentery  is  more  widely  distributed  over 
the  world  than  the  amoebic.    While  the  former  is  found  in  all 
Climates,  the  latter  ig  chiefly  restricted  to  warm  countries,    Biit 


22  SANITARY  REGULATIONS  AND 

persons  suffering  from  amoebic  dysentery  may  carry  the  disease 
from  a  warm  to  a  cold  climate. 

Sources  of  infection. — The  amoebae  and  bacilli  which  cause 
dysentery  are  contained  in  the  intestinal  contents  and  are  dis- 
charged with  them.  They  are,  therefore,  subject  to  the  same 
manner  of  distribution  as  are  the  typhoid  bacilli,  and  the  pre- 
ventive measures  to  be  employed  are  identical  with  those  em- 
ployed in  typhoid  fever.  It  may  be  well,  however,  to  emphasize 
the  common  occurrence  of  carriers  of  dysentery  bacilli  and 
amoebae  among  exposed  and  recovered  cases,  and  the  necessity  of 
enforcing  habits  of  personal  cleanliness  and  other  related  meas- 
ures to  control  the  disease. 

Diarrhea,  etc. — In  addition  to  dysentery,  slighter  and  non- 
dysenteric  forms  of  intestinal  trouble  are  more  or  less  common. 
As  the  results  of  chill  and  indiscretion  in  diet,  diarrhea,  griping, 
and  even  bloody  stools  may  arise.  But  any  case  of  persistent 
diarrhea  in  which  blood  and  mucus  are  being  discharged  should 
be  regarded  as  suspicious  and  submitted  to  a  laboratory  ex- 
amination, in  order  to  determine  whether  it  may  be  dysentery. 
The  amoebae  are  searched  for  by  direct  microscopical  examina- 
tion ;  the  bacilli  may  be  obtained  in  culture  or  an  agglutination 
test  made  with  the  patient's  blood  to  determine  their  presence. 

28.  The  intestinal  group  of  diseases. —  (a)  Typhoid  and  para- 
typhoid fever,  cholera,  and  amoebic  and  bacillary  dysentary  form 
a  group  of  intestinal  infections  in  which  the  causative  micro- 
organisms are  discharged  with  the  excreta,  and  gain  access  to 
healthy  persons  through  the  mouth.  The  general  principles  of 
their  prevention  are  practically  identical.  The  first  effort  made 
should  be  to  destroy  the  infectious  agents  at  the  source,  namely, 
in  the  discharges  from  the  intestine.  The  next  effort  should  be 
to  control  the  water  and  food  supply  and  the  personal  habits  of 
the  men,  so  that  any  of  the  microorganisms  which  escape  de- 
struction may  not  find  their  way  into  the  digestive  tract  in  a 
living  condition. 

(&)  No  man  should  be  employed  as  cook  or  handler  of  food 
or  water  who  is  a  carrier  of  B.  typhosus,  B.  paratyphosus,  A  or 
B,  or  cysts  of  Entamceba  histolytica. 

(c)  Stools  of  all  cooks  and  food  handlers  (including  handlers 
of  water  and  drivers  of  water  and  ice  wagons)  will  be  examined 
for  typhoid,  paratyphoid  A  and  B,  and  dysentary  bacilli,  and  for 
cysts  of  Entamceba  histolytica.  In  case  of  enlisted  men,  notation 
of  positive  findings  should  be  rna^e  on  tiie  service- pecorcl, 


CONTROL  OF  COMMUNICABLE  DISEASES.  23 

29.  Epidemic  meningitis. — Names. — Epidemic  meningitis,  cere- 
brospinal  meningitis,  and  cerebrospinal  fever  are  different  names 
for  one  and  the  same  disease.  In  certain  epidemics,  hemorrhages 
into  the  skin  are  common;  because  of  this  fact  the  disease  is 
also  called  spotted  fever. 

Cause. — The  bacterial  cause  of  epidemic  meningitis  is  a  diplo- 
coccus  called  meningococcus.  It  is  present  in  the  inflamed  mem- 
branes of  meninges  about  the  brain  and  spinal  cord  and  within 
the  ventricles  of  the  brain  of  those  ill  of  the  disease.  It  is  also 
present  upon  the  mucous  membranes  of  the  nose  and  throat  of 
the  ill,  and  even  of  the  well,  who  act  as  healthy  carriers  of  the 
diplococcus. 

Sporadic  cases. — Epidemic  meningitis  has  not  been  absent 
from  this  country  as  a  whole  in  many  years.  The  severe  epi- 
demics have  practically  disappeared,  but  occasional  or  sporadic 
cases  have,  nevertheless,  continued  to  arise.  From  time  to  time 
groups  of  cases  or  small  local  epidemics  have  also  appeared. 

Carriers. — The  healthy  carriers  of  the  meningococcus  are  more 
numerous  than  the  cases  of  the  disease  which  arise.  The  per- 
sistence of  the  sporadic  cases  indicates,  therefore,  the  continued 
existence  of  such  carriers  in  the  general  population.  The  as- 
sembling of  large  groups  of  men  from  various  parts  of  the  coun- 
try is  certain  to  introduce  carriers,  and  the  close  association  of 
the  carrier  with  other  persons  is  as  certain  to  lead  to  the  ap- 
pearance of  cases  of  epidemic  meningitis. 

Mode  of  infection. — Infection  with  the  meningococcus  takes 
place  by  way  of  the  mucous  membrane  of  the  nose  and  throat. 
Even  when  meningitis  does  not  arise  the  carriers  harbor  the 
diplococcus  upon  those  mucous  membranes.  They  are  present 
also  in  their  secretions,  and  gain  access  to  others  through  cough- 
ing, sneezing,  hawking,  and  spitting,  and  through  contact  of  the 
hands  contaminated  with  the  secretions. 

Sources  of  danger. — The  ill  patient  is  a  source  of  danger 
only  to  his  attendants,  because  he  is  kept  isolated  in  bed.  To 
reduce  this  danger  to  a  minimum  every  precaution  should  be 
taken  to  disinfect  or  destroy  the  discharges  from  the  nose  and 
throat.  This  is  necessary  primarily  in  the  interest  of  the  at- 
tendants— doctors  and  nurses — and  secondly  in  the  interest  of 
others,  since  doctor  or  nurse  may  be  converted  into  a  carrier. 

The  chief  danger  to  others  is  the  healthy  carrier,  because  he 
is  not  suspected  or  isolated  and  moves  about  freely.  He  can 
be  detected  by  means  of  a  bacteriological  examination,  and, 


24  SANITARY  REGULATIONS  AND 

having  been  detected,  .methods  exist  for  ridding  the  mucous 
membranes  of  the  diplococcus. 

The  occurrence  of  a  case  of  epidemic  meningitis  in  a  barrack, 
tent,  or  mess  is  the  signal  for  the  bacteriological  examination 
of  all  the  men  in  this  group.  Until  this  is  done,  the  men 
should  not  be  permitted  to  move  about  freely.  All  those  not 
found  to  be  carriers  can  be  at  once  released.  The  others  are 
released  as  soon  as  they  become  meningococcus  free.  Likewise 
the  convalescent  patient  is  not  released  until  a  bacteriological 
examination  has  shown  the  mucous  membranes  of  the  nose  and 
throat  to  be  free  of  the  meningococcus. 

Varieties  of  cases. — Two  main  clinical  varieties  of  epidemic 
meningitis  occur.  They  are  called  ordinary  and  fulminating 
or  explosive.  In  the  former  the  symptoms  come  on  and  de- 
velop gradually,  and  death  or  recovery  is  a  matter  of  one  or 
several  weeks.  In  the  latter  the  symptoms  appear  suddenly 
and  quickly  become  alarming,  and  death  may  result  in  a  few 
hours,  and  usually  does  occur  within  36  hours.  The  greatest 
number  of  recoveries  occur  among  the  ordinary  cases,  but 
recovery  has  been  observed  even  among  the  fulminant  ones. 
Recovery  from  both  is  now  more  frequent  as  the  result  of  the 
use  of  the  antimeningococcic  serum. 

Prevention. — No  certain  means  of  prevention  of  epidemic 
meningitis  is  known,  except  the  detection  and  removal  of  car- 
riers of  the  meningococcus  and  the  isolation  of  cases  of  the 
disease.  The  incidence  of  the  disease  is,  however,  influenced 
by  hygienic  conditions.  The  greatest  number  of  cases  tends  to 
occur  in  the  winter  when  people  are  much  indoors  and  ventila- 
tion is  deficient.  In  the  spring,  summer,  and  autumn,  when 
they  live  less  within  doors,  fewer  cases  arise.  Hence  the  ap- 
pearance of  the  disease  in  camps  is  an  indication  for  better 
separation  of  the  inmates.  The  less  they  are  in  intimate  con- 
tact the  smaller  the  danger  from  coughing,  sneezing,  etc. 
Moreover,  every  effort  should  be  made  to  prevent  sneezing, 
coughing,  hawking,  and  spitting,  except  under  conditions  in 
which  the  secretions  can  be  caught,  as  in  a  handkerchief. 
Cleanliness  of  person,  especially  of  the  hands,  is  also  a  safe- 
guard. 

Treatment. — The  treatment  most  relied  upon  consists  in  the 
injection  into  the  membrane  of  the  spinal  cord  and  brain  of  the 
antimeniugococcic  serum.  This  is  done  by  means  of  lumbar 
puncture,  a  certain  quantity  of  the  cerebrospinal  fluid  first  being 
removed.  This  fluid,  whicli  normally  is  perfectly  clear,  becomes 


CONTROL  OF  COMMUNICABLE  DISEASES.  25 

turbid  or  purulent  as  a  result  of  the  infection,  and  contains  the 
raeningococcus  and  leukocytes  and  other  cells.  The  diplococci 
are  partly  within  and  partly  without  the  leukocytes.  Removal 
of  the  cerebrospinal  fluid  is  of  benefit  because  it  withdraws  a 
certain  number  of  meningococci,  but  it  also  reduces  the  pres- 
sure within  the  ventricles  of  the  brain,  which  is  of  value.  The 
antimeningococcic  serum  acts  directly  upon  the  diplococci,  de- 
stroys them,  or  prevents  their  multiplication.  Hence  it  is  defi- 
nitely curative. 

The  serum  acts  only  as  long  as  it  is  within  the  meninges  or 
membranes  of  the  spinal  cord  and  brain,  and  as  it  escapes  into 
the  blood  its  injection  must  be  repeated.  The  rule  is  to  repeat 
the  injection  every  24  hours  for  two  or  three  or  more  days. 
In  severe  cases  it  has  been  found  of  advantage  to  repeat  the 
injection  every  12  hours.  The  detailed  methods  of  employing 
the  serum  and  of  treating  carriers  are  given  in  a  special 
circular. 

30.  Malaria. — Cause. — Malaria  is  caused  by  a  microorganism 
(plasmodium  malarise)  which  gains  access  to  the  body  through 
the  bites  of  mosquitoes  belonging  to  the  genus  Anopheles. 

The  predisposing  causes  of  the  disease  are  those  that  favor 
the  development  of  mosquito  life. 

On  account  of  the  nocturnal  habits  of  the  malaria-bearing 
mosquitoes,  the  disease  is  more  likely  to  be  contracted  at  night. 

Prevention. — Camps  should  not  be  located  near  swamps  or  in 
places  where  standing  water  favors  the  development  of  the  mos- 
quito. Every  precaution  will  be  taken  to  destroy  breeding 
places  by  draining  and  filling,  or  by  oiling  them,  and  by  the 
cutting  away  of  all  grass  or  undergrowth  for  a  distance  of  200 
yards  about  camps  and  habitations  in  order  that  the  adult 
mosquitoes  may  not  find  lodgment  and  protection. 

In  certain  conditions,  the  use  of  preventive  doses  of  quinine 
may  be  required,  and  administered  by  order  under  the  super- 
vision of  the  medical  officer.  All  cases  of  malaria  will  be 
promptly  isolated  for  treatment  and  protected  from  the  attack 
of  mosquitoes. 

See  also  paragraphs  195-197,  Manual  for  the  Medical  Depart- 
ment. 

31.  Yellow  fever  is  transmitted  by  the  bite  of  the  yellow-fever 
mosquito   (Stegomyia  calopus). 

Yellow  fever  is  essentially  a  disease  of  the  Tropics,  and  its 
existence  is  dependent  upon  the  distribution  of  this  single 
species  of  mosquito,  small  and  silver  striped,  active  principally 


26  SANITARY  REGULATIONS  AND 

at  evening  time,  and  breeding  generally  in  small  accumulations 
of  water  close  to  the  habitations  of  man. 

The  prevention  of  this  disease,  as  of  malaria,  depends  chiefly 
on  the  destruction  of  the  mosquito  and  its  breeding  places,  the 
proper  protection  against  the  bites  of  the  insects  at  all  times, 
and  the  early  isolation,  protection,  and  treatment  of  each  case 
of  yellow  fever  as  soon  as  suspected. 

32.  Typhus  fever. — Definition. — Typhus  fever  is  an  acute  in- 
fectious disease  caused  by  a  specific  germ,  characterized  by  sud- 
den onset,  high  fever,  marked  nervous  symptoms,  and  macular 
eruption.     It  has  prevailed  in  Mexico  and  in  eastern  Europe 
since  the  middle  of  the  sixteenth  century. 

Transmission. — Typhus  fever  is  transmitted  to  man  only  by 
the  bite  of  the  louse,  which  infests  the  clothing  and  body  of  tha 
victims. 

Prevention. — The  prevention  of  typhus  fever  depends,  there- 
fore, upon  personal  cleanliness  and  the  avoidance  and  destruc- 
tion of  infected  lice. 

Frequent  bathing  and  cleansing  of  clothing,  with  repeated 
inspection  of  garments,  particularly  the  seams  where  the  eggs 
of  the  louse  are  deposited,  are  imperative  precautions. 

The  clothes  louse  lays  its  eggs  among  and  attached  to  the 
fibers  of  clothes,  with  a  special  preference  for  seams  and  lin- 
ings, a  point  to  be  remembered  in  the  destruction  of  lice. 

The  eggs  are  the  size  of  a  pin  point,  yellowish  white  in  color, 
goblet-shaped,  and  attached  at  the  lower  end  of  the  cloth  by  a 
cement  excreted  by  the  female.  They  can  be  destroyed  by  boil- 
ing water  or  kerosene.  In  this  connection  see  Bulletin  No.  10, 
War  Department,  1916. 

The  avoidance  of  buildings,  places,  and  persons  known  to  be 
infected  with  lice  is  of  first  importance. 

In  case  troops  are  sent  into  a  typhus  area,  a  railway  disin- 
fecting and  bathing  train  will  be  provided,  and  stationary  plants 
of  like  character  at  the  bases. 

33.  Epidemic  jaundice. — Cause. — Epidemic  jaundice  is  caused 
by  a  spirochete,  which  is  abundant  in  the  urine  and  feces  of 
convalescents,  and  is  also  frequently  found  in  the  kidneys  of 
rats.     This  spirochete  lives  for  some  time  in  water,  and  the 
disease  is  contracted  by  standing  in  contaminated  water,  and 
less  frequently  by  eating  contaminated  food. 

Prevention. — Prevention  consists  in  isolation  of  all  cases 
until  the  urine  is  free  from  spirochetes,  avoidance  of  urine  and 
fecal  contamination  of  trenches,  destruction  of  rats,  the  protec- 


CONTROL  OF  COMMUNICABLE  DISEASES.  27 

tion  of  food,  and  keeping  trenches  free  from  water.  If  the 
trenches  become  contaminated  water  should  be  pumped  out  and 
lime  sprinkled  freely  over  the  soil. 

34.  Smallpox. — Any  case  of  smallpox  occurring  among  persons 
subject  to  military  control  will  be  isolated,  and  contacts  not 
protected  by  recent  successful  vaccination  will  be  revaccinated. 

35.  Vaccination. — Vaccination  being  recognized  as  an  effective 
means  of  preventing  smallpox,  all  recruits  upon  enlistment  and 
all  soldiers  upon  reenlistment  will  be  vaccinated.     When  the 
first  vaccination  of  a  recruit  is  ineffective,  it  will  be  repeated  at 
the  end  of  eight  days. 

All  the  personnel  of  a  military  command,  station,  or  trans- 
port, including  civilians  connected  therewith,  will  be  vaccinated 
when  in  the  opinion  of  the  medical  officer  responsible  for  sanita- 
tion it  is  necessary  as  a  means  of  protection  against  smallpox. 
Civilians  refusing  to  be  vaccinated  when  so  directed  by  proper 
authority  may  be  excluded  from  the  military  reservation  or 
station. 

Officers  should  be  vaccinated  at  least  once  in  a  period  of 
seven  years.  Troops  under  orders  to  perform  oversea  journeys 
or  field  service  will  be  inspected  by  the  responsible  medical 
officer  with  respect  to  their  protection  against  smallpox,  and 
those  who  in  his  opinion  require  it  will  be  vaccinated. 

Technique. — The  skin  at  the  selected  site  must  be  clean. 
Washing  with  warm  water,  followed  by  alcohol,  Is  usually  suffi- 
cient, the  alcohol  being  permitted  to  evaporate  before  proceed- 
ing. Scrubbing  with  soap  and  water  is  necessary  for  a  dirty 
skin,  but  needless  irritation  of  the  skin  Is  to  be  avoided. 

The  procedure,  described  as  follows,  is  preferable  to  "  scarifi- 
cation," which  will  no  longer  be  used : 

Incision  is  the  method  of  choice,  and  should  be  made  with  the 
point  of  a  sterile  needle,  producing  a  "scratch."  A  sterile 
scalpel  may  be  used,  but  is  more  likely  to  cause  bleeding.  The 
incision  or  scratch  should  preferably  not  draw  blood.  There 
should  be  at  least  two  incisions,  three-quarters  of  an  inch  long 
and  1  inch  apart;  after  exposure  to  smallpox  four  incisions  will 
be  made.  The  virus  is  then  placed  upon  the  abraded  surface 
and  gently  rubbed  in,  unnecessary  irritation  being  avoided. 

The  wound  is  allowed  to  dry  thoroughly  and  can  be  left  with-- 
out  dressing,  though  several  layers  of  gauze  may  be  applied 
with   adhesive  plaster.     Any  dressing   that  retains  heat  and 
moisture  is  bad.    Shields  will  no  longer  be  issued. 


28  SANITARY  REGULATIONS,  ETC. 

Bathing  is  permitted,  but  unnecessary  use  of  the  limh  is  to 
be  discouraged  when  practicable. 

36.  Measles,  mumps,  and  scarlet  fever. — When  these  diseases 
appear  in  a  command  all  cases  of  illness  with  catarrhal  symp- 
toms having  a  temperature  of  101°  or  over  will  be  promptly 
isolated,  and  the  general  preventive  measures  used  against  the 
contagious  respiratory  diseases  will  be  instituted.     Susceptible 
contacts  will  be  isolated  and  inspected  daily. 

If  practicable,  a  detention  camp  will  be  established  where  all 
recently  joined  recruits  will  be  held  under  observation  before 
being  permitted  to  join  their  organizations. 

37.  Venereal  diseases. — See  paragraph  13. 


INDEX. 


Paragraph. 

Barracks,  ventilation  of 12 

Bathing,  requirements 12,  24 

Baths,  inspection  of 8 

Cholera,  cause,  nature,  and  prevention 26 

Clothing,  regulations  concerning 12,  24,  26,  32 

Commanders,  responsibility  of 1 

Diseases : 

Communicable 19 

Contraction  of "2'2 

Intestinal  groups  of ^ 28 

Venereal 13,  37 

Drinking  cup,  common,  use  of,  prohibited 5 

Drinks,  precautions  relative  to 7 

Dysentery,  causes,  nature,  and  infection 27 

Excreta,  disposal  of 11 

Feet,  care  of 14 

Flies,  destruction  of  breeding  places 18 

Flytraps,  description  and  use 6 

Food,  instructions  concerning 7 

Garbage,  disposal  of :  9 

Infection,  routes  of 22 

Inspection,  physical  and  sanitary 15, 16 

Inspector,  sanitary,  responsibility  of 3 

Jaundice,  epidemic  of,  cause  and  prevention 33 

Kitchens  and  mess  halls 6 

Lavatories,  inspection  of 8 

Malaria,  cause  and  prevention 30 

Manure,  disposal  of 10 

Measles,  isolation  and  prevention 36 

Meningitis,  isolation,  prevention,  and  treatment 29 

Mosquito,  breeding,  prevention  of 17 

Mumps,  isolation  and  prevention 36 

Paratyphoid  fever,  cause,  nature,  and  protection  against-  25 

Physical  examination 15 

Picket  line,  care  of 10 

29 


30  INDEX. 

Paragraph. 

Policing,  commanders  responsible  for 1 

Revaccination,  instructions  governing 34,  35 

Sanitary  science,  object  of 20 

Sanitation,  military 23 

Sanitation,  responsibility  for 1 

Sanitary  inspections,  instructions  governing 16 

Sanitary  squads,  organization  of 4 

Scarlet  fever,  isolation  and  prevention 36 

Shoes,  fitting  of 14 

Smallpox,  isolation  of 34 

Stoppage  of  pay,  while  under  treatment  for  venereal  dis- 
eases   13 

Surgeon,  division,  responsibility  of 2 

Teeth,  care  of 12 

Tents,  ventilation  and  sanitation 12 

Typhoid  fever,  cause  and  prevention 24 

Typhus  fever,  definition,  transmission,  and  prevention 32 

Vaccination,  instructions  governing 25,  34,  35 

Venereal  diseases,  instructions  relative  to 13 

Waste  water,  inspection  of 8 

Water  supply,  care  of '. 5 

Yellow  fever,  prevention  of 31 

o 


IC.3.S.ILN0.2&J 


SPECIAL  REGULATIONS  NO.  28. 

CHANGES  }  WAR  DEPARTMENT, 

No.  3.    J  WASHINGTON,  September  20,  191S. 

Paragraph  14,  Special  Regulations  No.  28,  Sanitary  Regula- 
tions and  Control  of  Communicable  Diseases,  is  changed,  us 
follows : 

14.  (Changed  by  S.  R.  No.  28,  C.  No.  3,  W.  D.,  1918.)— Fitting 
of  shoes  and  care  of  feet. — With  the  view  of  increasing  the 
marching  capacity  of  troops,  company,  troop,  battery,  and  de- 
tachment commanders  will  personally  satisfy  themselves  that 
the  men  of  their  commands  have  been  properly  measured  and 
fitted  with  shoes  and  socks,  and  will  be  held  responsible  that 
the  instructions  herein  contained  as  to  care  of  feet  are  strictly 
followed,  and  that  their  men  are  required  to  wear  shoes  and 
socks  properly  fitted. 

Foot-measuring  machines  and  shoe-fitting  devices  will  be  sup- 
plied by  the  Quartermaster  Corps  in  such  nunii>. vs  us  may  be 
needed  at  each  camp  and  garrison  post  in  th£  I"  nit- -I  States,  the 
Philippine,  Panama  Canal,  and  Hawaiian  Dcp;  •  tm-  nts  for  use 
in  fitting  shoes.  The  use  of  the  measuring  machines  and  the 
fitting  devices  is  to  be  under  the  general  supervision  of  the  unit 
supply  officers  and  supply  officers  of  depot  brigades,  to  whose 
offices  will  be  attached  personnel  properly  instructed  in  meas- 
uring and  shoe  fitting.  A  record  of  the  proper  size  and  width 
of  shoes  as  determined  by  use  of  the  foot-measuring  machine 
and  shoe-fitting  devices  and  of  the  proper  size  of  woolen  sock 
will  be  kept  by  company,  troop,  battery,  and  detachment  com- 
manders. 

DIRECTIONS    FOB    OPERATING    "  KESCO "    FOOT-MEASURING     MACHINE. 

(a)  After  taking  the  machine  from  it.cj  box,  open  it  wide  by 
moving  the  lever  as  far  front  as  possible  and  pulling  out  the 
plunger  as  far  as  it  will  go.    The  machine  is  now  ready  for  use. 

(b)  Let  the  man  put  his  foot  in  the  machine  and  stand  with 
all  his  weight.     The  heel   should  rest  lirmly  ;» gainst  the  heel 
block.     It  is  important  that  the  foot  should  rest  in  the  exact 
center  of  tin;  machine. 

(c)  Release  lever  which  operates  the  width  indicator  and 
push  the  plunger  until  the  plate  touches  the  toe.    Do  not  touch 
the  plunger  again  while  the  foot  is  in  the  machine.    Make  sure 
that  the  metal  side  pieees  touch  the  toe  joints. 

(d)  Then  let  the  man  throw  his  entire  weight  on  the  bull  of 
his  foot,  misin.L'  the  heel  slightly. 

°— - 18 


S.  R.  No.  28.] 


(e)  The  width  is  automatically  registered  by  the  arrow.  As 
the  arrow  wavers,  following  the  action  of  the  heel  up  and  down, 
take  the  average  of  the  extremes.  (Example:  If  the  arrow 
Wavers  from  width  "b"  to  width  "d,"  use  width  "c.")  The 
correct  size  of  the  shoe  is  indicated  by  the  pointer  on  the  plunger 
on  the  right-hand  scale. 

(/)  Measure  the  other  foot  in  the  same  manner,  and  if  there 
should  be  a  difference,  select  size  to  fit  the  longer  foot  and  the 
narrower  width. 

(g)  Oil  the  slide  under  the  device  occasionally. 

NOTE. — Verify  the  length  selected  by  testing  with  shoe-fitting 
device.  v 

INSTBUCTIONS  FOB  USING  THE  SHOE-FITTING  DEVICE. 

(a)  Select  from  the  several  measuring  devices  in  the  set  the 
one  marked  with  the  size  or  half  size  corresponding  with  the 
shoes  to  be  tried  on. 

(6)  Insert  the  knob  end  of  the  device  into  the  toe  of  the 
shoe,  springing  the  other  end  of  device  down  to  the  inner  sole, 
against  the  counter. 

(c)  The  middle  of  the  flat  spring  piece  will  lie  flat  with  slight 
pressure  of  the  foot. 

(d)  If  the  soldier,  with  pack  and  rifle  on  his  back,  can  with- 
out discomfort  pace  back  and  forth  in  shoes  with  device  in- 
serted, the  shoes  will  be  sufficiently  long  to  allow  for  foot  ex- 
pansion when  device  is  withdrawn. 

NOTE. — The  shoes  must  in  every  case  pass  satisfactorily  I  he 
above  described  test. 

Shoes  of  the  size  indicated  by  measuring  machine,  fitted  with 
the  proper  shoe-fitting  device,  will  be  laced  snugly ;  and  the 
soldier,  with  a  40-pound  burden  on  his  back,  will  throw  his 
entire  weight  upon  one  foot.  The  officer  or  enlisted  man  will 
grasp  with  his  hand  the  leather  of  the  shoe  over  the  ball.  As 
his  fingers  and  thumb  are  brought  slowly  together  over  the 
leather  the  shoe  should  feel  snugly  filled  without  apparent  ten- 
sion, while  the  leather  should  lie  smoothly  under  the  hand. 
If  the  leather  wrinkles  under  the  grasp  of  the  hand  the  shoe  is 
too  wide  and  a  narrower  width  is  needed;  if  the  leather  seems 
tense  and  bulgy  and  the  hand  tends  to  slip  over  easily,  the 
shoe  is  too  narrow  and  a  greater  width  Is  necessary.  Usually 
it  will  be  necessary  to  try  on  several  pairs  of  shoes  in  this 
manner  before  an  entirely  satisfactory  shoe  is  secured.  No 
shoes  will  be  issued  or  worn  by  enlisted  men  which  are  not  fitted 
in  accordance  with  this  order. 

When  foot-measuring  machines  and  shoe-measuring  devices 
are  not  available,  the  procedure  in  determining  the  fact  of  fit  of 
the  shoes  will  be  the  same  as  contained  in  the  preceding  para- 
graph. The  officer  or  enlisted  man  fitt'ng  the  shoe  will  also 
press  in  the  leather  of  the  shoes  in  front  of  the  toes  to  determine 
the  existence  of  sufficient  vacant  space  in  that  region  to  prevent 


[C.  3,  S.  II.  No.  28.] 
3 

toe  injury.  Under  no  circumstances  should  this  vacant  space 
in  front  of  the  great  toe  be  less  than  two-thirds  of  an  inch,  or 
the  width  of  a  man's  thumb,  nor  should  there  be  pressure  on 
top  of  the  toes. 

Measurements  will  be  taken  and  shoes  will  be  fitted  as  soon 
as  practicable  after  the  enlistment  or  induction  of  the  soldier 
into  the  service,  and  the  record  will  be  changed  from  time  to 
time  if  subsequent  fittings  render  a  change  necessary. 

S  zes  called  for  in  requisitions  will  conform  to  the  record,  and 
the  fact  of  fit  of  shoes  and  socks  issued  on  such  requisition  will 
be  personally  verified  in  every  instance  by  a  company,  troop, 
battery,  or  detachment  officer. 

New  shoes  should  be  adapted  to  the  contours  of  the  feet  as 
soon  as  possible.  Shoe  stretchers,  with  adjustable  knobs  to 
take  pressure  off  painful  corns  and  bunions,  are  issued  by  the 
Quartermaster  Corps. 

All  shoes  and  socks  must  be  properly  broken  in  before  begin- 
ning to  march.  The  following  is  suggested,  but  not  required : 
The  soldier  stands  in  his  new  shoes  in  about  2$  inches  of 
water  for  about  five  minutes,  until  the  leather  is  thoroughly 
pliable  and  mo'st;  he  should  then  walk  for  about  an  hour  on 
the  level  surface,  letting  the  shoes  dry  on  his  feet,  to  the 
irregularities  of  which  the  leather  is  thus  molded  in  the  same 
way  as  it  was  previously  molded  over  the  shoe  last.  On  taking 
the  shoes  off  a  very  little  neat?s-foot  oil  should  be  rubbed  into 
the  leather  to  prevent  its  hardening  and  cracking. 

If  it  is  desired  to  waterproof  the  shoes  at  any  time,  a  con- 
siderable amount  of  dubbin  should  be  rubbed  into  the  leather. 

Shoes  issued  to  enlisted  men  will  be  regularly  inspected  by 
company,  troop,  battery,  and  detachment  commanders  to  see 
that  waterproofing  substance  is  applied  often,  and  that  they  are 
not  injured  by  being  placed  too  near  heating  apparatus.  Heat 
ruins  leather  and  causes  wet  leather  to  decompose  rapidly. 

Light  or  heavy  woolen  socks  will  be  worn  habitually  for 
marching;  the  socks  will  be  large  enough  to  permit  free  move- 
ment of  the  toes,  but  not  so  loose  as  to  permit  of  wrinkling. 
Darned  socks  or  socks  with  holes  will  not  be  worn  in  marching. 
(This  is  not  to  be  construed,  however,  as  prohibiting  soldiers 
from  wearing  properly  darned  socks  while  on  ordinary  duty, 
at  drill,  etc.  If  on  marches  two  pairs  of  socks  are  worn,  the 
outer  pair  may  be  darned  socks.)  Woolen,  socks  will  shrink 
about  one  size  after  being  washed  a  few  times.  Proper  fitting 
of  socks  must  be  secured  under  personal  supervision  of  a  com- 
pany, troop,  or  battery  officer. 

Company,  troop,  battery,  and  detachment  commanders,  by 
frequent  inspections  and  care  throughout  the  year,  will  main- 
tain  the  feet  of  their  men  in  condition  for  proper  marching. 
They  will  cause  the  proper  tr'mming  of  nails,  removal  or  pnring 
of  corns  and  callouses,  relief  of  painful  bunions,  treatment  of 
ingrowing  nails  and  other  defects,  sending  serious  cases  to  the 
surgeon. 


[C.  3,  S.  R.  No.  28.) 


Before  a  march  is  undertaken  by  foot  troops,  company,  troop, 
battery,  and  detachment  officers  will  personally  inspect  the 
bare  feet  of  their  men.  While  on  the  march  they  will  per- 
sonally see  each  day  that  their  men  wash  their  feet  as  soon 
as  possible  after  reaching  camp,  prick  and  evacuate  blisters, 
and  cover  such  blisters  or  excoriations  with  zinc-oxide  plaster 
supplied  by  the  medical  department,  applied  hot,  dust  the  feet 
with  a  foot  powder  supplied  by  the  medical  department,  and 
put  on  clean  socks.  Hereafter  an  undue  amount  of  foot  injury 
and  disability  from  shoes  will  be  regarded  as  evidence  of  ineffi- 
ciency on  the  part  of  officers  concerned  and  as  causes  for 
investigation. 

A  place  will  be  provided  where  officers  may  have  shoes  fitted 
for  the  purpose  of  determining  or  verifying  the  record.  For  the 
purpose  of  fitting,  unit  supply  officer  will  draw  from  the  camp 
quartermaster,  on  memorandum  receipt,  a  try-on  set  consisting 
of  a  complete  series  of  each  size  and  width  of  shoes  furnished 
for  issue.  Shoes  of  this  series  will  be  put  in  stock  and  issued 
before  they  become  unserviceable,  and  will  be  replaced  by  new 
shoes,  keeping  the  series  always  complete.  Company,  troop, 
battery,  and  detachment  commanders  will  report  in  writing  to 
the  post  or  regimental  commander  every  instance  of  failure  to 
secure  proper  shoes  for  their  command.  Post  or  regimental  com- 
manders will  investigate  the  reasons  for  and  be  held  responsible 
as  far  as  lies  in  their  power  for  the  rectification  of  such  defi- 
ciencies. 

A  brief  record  of  the  number  of  such  reports  from  company, 
troop,  battery,  and  detachment  commanders,  and  the  reason  for 
such  deficiencies  will  be  furnished  to  inspectors  at  each  inspec- 
tion of  the  post. 

Inspections  conducted  under  the  provisions  of  paragraph  889, 
Army  Regulations,  will  embrace  an  inquiry  into  the  manner  in 
which  this  paragraph  has  been  complied  with,  and  the  report  of 
inspections  will  include  a  statement  of  all  instances  of  failure 
on  the  part  of  company,  troop,  battery,  and  detachment  com- 
manders, to  secure  proper  shoes  for  their  commands  and  the 
cause  of  such  failure.  (8.  R.  No.  28,  C.  No.  3,  Sept.  20,  1918.} 
[421.5,  A.  G.  O.] 

BY  ORDER  OF  THE  SECRETARY  OF  WAR  I 

PEYTON  O.  MARCH, 

General,  Chief  of  Staff, 
OFFICIAL  : 

P.  C.  HARRIS, 

Acting  The  Adjutant  General. 


:  GOVEB.XMEXX  PEIXTIXG  OFFICE  : 


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